It is very important to us at Excelsior Springs Hospital to provide the best care possible to the residents in our Long Term Care Facility. Please assist us in evaluating the care provided from your perspective. Your response to this survey will be kept confidential. Thank you for taking the time to complete this survey. 
 
 

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* 1. In general, how would you rate the overall care received from nursing staff?

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* 2. How would you rate the overall care received from the physicians?

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* 3. How would you rate the care given by the activities staff?

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* 4. How would you rate the assistance given by Social Services?

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* 5. How would you rate the resident's room appearance? 

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* 6. How would you rate the overall facility appearance?

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* 7. How would you rate the general atmosphere of the facility in regards to friendliness and professionalism? 

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* 8. Does the staff greet you and speak with you courteously?

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* 9. Do you feel you are notified of significant changes in your relative's/friend's health in a timely manner?

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* 10. If applicable, are the staff accommodating so you are able to participate in service/care planning to the extent that you want? 

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* 11. How would you rate the dining services offered to the residents?

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* 12. Do you think the meals are appetizing and nourishing?

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* 13. Do you think the residents get plenty to eat?

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* 14. How would you rate the level of activities offered to the residents?

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* 15. If able, is the resident free to use a phone to contact you? If not able, does a staff member contact you on behalf of the resident?

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* 16. Do you know whom to contact if you have a concern regarding care of a resident?

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* 17. Do you know whom to contact if you need financial information or assistance?

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* 18. If appropriate, have you been adequately informed about the cost of services offered in the facility?

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* 19. Are you aware that the contact information for the ombudsman is posted near the nurse's station?

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* 20. Are you aware that diet permitting, residents can receive snacks such as cookies, ice cream and popcorn free of charge?

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* 21. Are you aware that copies of the last 3 years state inspections are located by the nurses' station?

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* 22. Do you think the resident's room is comfortable, homelike and reflects what the resident would like?

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* 23. Do you have any suggestions on how we can make improvements to our facility, care, etc.?

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* 24. What do you like best about our Long Term Care Facility?

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* 25. Would you recommend our facility to others?

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* 26. Optional:

Thank you for your time!
Please return the form in the envelope provided. 


Valerie Jeffres
Long Term Care Administrator 
1700 Rainbow Blvd.
Excelsior Springs, MO 64024

816-629-3572
vjeffres@esmc.org 

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